Progression of atherosclerosis with carnitine supplementation: a randomized controlled trial in the metabolic syndrome.

Background: L-carnitine (L-C), a ubiquitous nutritional supplement, has been investigated as a potential therapy for cardiovascular disease, but its effects on human atherosclerosis are unknown. Clinical studies suggest improvement of some cardiovascular risk factors, whereas others show increased plasma levels of pro-atherogenic trimethylamine N-oxide. The primary aim was to determine whether L-C therapy led to progression or regression of carotid total plaque volume (TPV) in participants with metabolic syndrome (MetS).

Prophylactic warfarin post anterior ST-elevation myocardial infarction: A systematic review and meta-analysis.

Objectives: To determine the role of warfarin (WF) prophylaxis in the prevention of left ventricular thrombus (LVT) formation and subsequent embolic complications following an anterior ST elevation myocardial infarction (STEMI) complicated by reduced left ventricular ejection fraction (LVEF) and wall motion abnormalities.

Background: The role of oral anticoagulation prophylaxis, in addition to dual antiplatelet therapy (DAPT), in the current era of percutaneous coronary intervention has not been well studied, despite being a class IIb recommendation in the AHA/ACC STEMI guidelines.

Methods: The Cochrane search strategy was used to search PubMed, Embase and the Cochrane library for relevant results.

Lack of independent effect of type 2 diabetes beyond characteristic comorbidities and medications on small muscle mass exercising muscle blood flow and exercise tolerance.

Persons with type 2 diabetes (T2D) are believed to have reduced exercise tolerance; this may be partly due to impaired exercising muscle blood flow (MBF). Whether there is an impact of T2D on exercising MBF within the typical constellation of comorbidities (hypertension, dyslipidemia, obesity) and their associated medications has not been investigated. We tested the hypothesis that small muscle mass exercise tolerance is reduced in persons with T2D versus Controls (matched for age, body mass index, fitness, comorbidities, non-T2D medications) and that this is related to blunted MBF.

Independent effect of type 2 diabetes beyond characteristic comorbidities and medications on immediate but not continued knee extensor exercise hyperemia.

We tested the hypothesis that type 2 diabetes (T2D), when present in the characteristic constellation of comorbidities (obesity, hypertension, dyslipidemia) and medications, slows the dynamic adjustment of exercising muscle perfusion and blunts the steady state relative to that of controls matched for age, body mass index, fitness, comorbidities, and non-T2D medications. Thirteen persons with T2D and 11 who served as controls performed rhythmic single-leg isometric quadriceps exercise (rest-to-6 kg and 6-to-12 kg transitions, 5 min at each intensity). Measurements included leg blood flow (LBF, femoral artery ultrasound), mean arterial pressure (MAP, finger photoplethysmography), and leg vascular conductance (LVK, calculated).

Performance of the "CCS Algorithm" in real world patients.

Background: With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee has introduced a new triage and management algorithm; the so-called "CCS Algorithm". The CCS Algorithm is based upon expert opinion of the best available evidence; however, the CCS Algorithm has not yet been validated. Accordingly, the purpose of this study is to evaluate the performance of the CCS Algorithm in a cohort of real world patients.

Identifying patients at low risk for activity-related events: the RARE Score.

Purpose: To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately identifies patients who are at low risk of experiencing an adverse event while exercise training at cardiac rehabilitation.

Methods: Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score < 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented.

High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors.

Aim: Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health and decreases death and disability following a cardiovascular event. Traditional CR typically involves 36 on-site exercise sessions spanning a 12-week period. To date, the optimal dose of CR has yet to be determined.

A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation.

Aims: The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime for the prevention of stroke in patients who are newly diagnosed with non-valvular atrial fibrillation.

Methods And Results: The CHA(2)DS(2)-VASc and HAS-BLED scoring systems were used to assess patients' baseline risks of stroke and major bleeding, respectively.

Comparison of the efficacy of administering a combination of ezetimibe plus fenofibrate versus atorvastatin monotherapy in the treatment of dyslipidemia.

Background: This trial compares the efficacy of administering a combination of ezetimibe plus fenofibrate as an alternative to statin monotherapy for the treatment of dyslipidemia. In this randomized, unblinded crossover study, 43 patients with documented hypercholesterolemia requiring pharmacotherapy were randomized to receive six weeks of either a combination of 10 mg of ezetimibe plus 160 mg of fenofibrate (combination) or 10 mg of atorvastatin monotherapy (atorvastatin). The primary endpoint was the percentage reduction of low-density lipoprotein cholesterol (LDL-C).

Efficacy of alternate day versus daily dosing of rosuvastatin.

Background: Compared with other statins, rosuvastatin has a relatively long half-life, which may allow for the administration of this medication on an alternate day basis.

Objective: To compare the efficacy of administering rosuvastatin on a daily basis versus on an alternate day basis for the treatment of dyslipidemia.

Methods: In the present crossover study, 45 patients with documented hypercholesterolemia requiring pharmacotherapy were administered either 20 mg of rosuvastatin on alternate days or 10 mg of rosuvastatin daily for six weeks.

Plasma PCSK9 levels are significantly modified by statins and fibrates in humans.

Background: Proprotein convertase subtilisin kexin-like 9 (PCSK9) is a secreted glycoprotein that is transcriptionally regulated by cholesterol status. It modulates levels of circulating low density lipoprotein cholesterol (LDLC) by negatively regulating low density lipoprotein receptor (LDLR) levels. PCSK9 variants that result in 'gain of function' have been linked to autosomal dominant hypercholesterolemia, while significant protection from coronary artery disease has been documented in individuals who carry 'loss of function' PCSK9 variants.

Comparison between a low glycemic load diet and a Canada Food Guide diet in cardiac rehabilitation patients in Ontario.

Background: A high dietary glycemic load is associated with an increased risk of noninsulin-dependent diabetes mellitus and coronary artery disease.

Objective: To evaluate the effect of a low glycemic load diet on cardiac rehabilitation patients.

Methods: One hundred twenty patients who were advised to follow a low glycemic load diet were evaluated and compared with 1434 patients who were advised to follow the principles of Canada's Food Guide to Healthy Eating for People Four Years and Over as part of the Ontario Cardiac Rehabilitation Pilot Project.